Impact of Model for End-Stage Liver Disease allocation system on outcomes of deceased donor liver transplantation: A single-center experience

Abstract

Backgrounds/Aims: From June of 2016, the Model for End-Stage Liver Disease (MELD)-based allocation system replaced the Child-Turcotte-Pugh (CTP) score-based system for organ allocation liver in Korea. The aim of this study was to analyze changes in outcomes and arising issues before and after the implementation of the MELD system. Methods: From June 2014 to June 2018, 129 patients were selected from recipients who underwent deceased donor liver transplantation (DDLT) in Seoul National University Hospital. Pediatric cases were excluded. According to the allocation system, patients were divided into two groups (52 in the MELD group and 77 in the CTP group). Results: MELD scores of the two groups differed significantly (37.8 ± 2.0 in the MELD group vs. 31.0 ± 8.2 in the CTP group; p = 0.001). The etiology of patients was changed for liver transplantation. The proportion of alcoholic liver cirrhosis increased in the era of the MELD allocation system. However, proportions of hepatitis B related liver cirrhosis and hepatocellular carcinoma were decreased. Six-month mortality rate of the MELD group was 25.0%, which was higher than that (11.7%) of the CTP group (p = 0.022). The 90-day complication rate was significantly higher in the MELD group than in the CTP group (11.5% vs. 2.6%; p = 0.040). Conclusions: When the MELD allocation system was used to distribute livers to severely ill patients, it resulted in poorer outcomes after surgery and higher proportion of alcoholic cirrhosis. Thus, it is necessary to adjust the MELD allocation system so that outcomes after DDLT could be improved.

The impact of Model for End-Stage Liver Disease score on deceased donor liver transplant outcomes in low volume liver transplantation center: a retrospective and single-center study

“…The reasons for the difference in mortality rate between the 2 groups were related to the higher proportion of alcoholic liver cirrhosis patients in the post-MELD group and the MELD score difference between the 2 groups. A recent study reported that 6-month mortality in pre-MELD group (n = 77) and post-MELD group (n = 52) were 11.7% and 25.0%, respectively (P = 0.022) [ 14 ]. In multivariate analysis [ 14 ], MELD/CTP allocation was the only factor that showed significant association with higher 6-month mortality than the CTP allocation system (HR, 2.865; 95% CI, 1.057–7.764; P = 0.039).…”

“…A recent study reported that 6-month mortality in pre-MELD group (n = 77) and post-MELD group (n = 52) were 11.7% and 25.0%, respectively (P = 0.022) [ 14 ]. In multivariate analysis [ 14 ], MELD/CTP allocation was the only factor that showed significant association with higher 6-month mortality than the CTP allocation system (HR, 2.865; 95% CI, 1.057–7.764; P = 0.039). However, MELD score and organ ischemic time were classified as risk factors for 6-month mortality rate in the current study.…”